Most of the 13 state-run public health insurance have collectively spent $4.8 billion in federal funding during their first 17 months of operations and face serious cash-flow problems, according to a website named after the late conservative commentator Andrew Breitbart.

And with major insurance carriers seeking HIX premium increases of up to 51% in some states, the report suggested marketplace mergers as one political solution. It noted that both Covered California and Vermont Health Connect significantly overestimated enrollment and now must slash advertising, outreach and technology services.